Virginia Premier Health Plan, Inc.

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Cost Containment Business Analyst I

Cost Containment Business Analyst I

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4285

Job Description

Overview

This position is responsible for supporting the Cost Containment Unit in drafting, documenting and gathering business and technical requirements related to initiatives which support the Unit’s efforts to provide corporate services in Recovery and Cost Avoidance as related to Claims payments. The individual will act as a liaison between VPHP and the external Cost Containment vendors employed, assuring compliance with all regulations while maximizing efficiencies and return on investment. Participate in developing new opportunities and engage in new vendor selection as required. 

 

Responsibilities

  • Execute reports related to Cost Containment initiatives.
  • Draft newly created process flows and maintain present process flows and related documentation.
  • Draft Standard Operating Procedures and maintain updates to changes made on existing documents under guidance of Manager.
  • Research, gather and document requirements for adhoc reporting, project initiatives and new vendor or business development opportunities in compliance with all contractual obligations, including DMAS and CMS.
  • Document all project status updates including contact information, overview, barriers, next steps and accomplishments.
  • Document and maintain all task schedules and related deliverables via SharePoint repository.
  • Ensure all reports have been compiled and delivered to appropriate parties as scheduled.
  • Act as liaison between vendors and VPHP as required. Escalate issues of concern and monitor vendor effectiveness.
  • Gain understanding of all VPHP systems and tools including DBMS, SQL, Access, Excel, IDX, QNXT, Data Warehouse extract tools, automation tools as well as FTP protocols including both setup and maintenance.
  • Assist in identifying and developing further recovery and avoidance opportunities; refine and maintain after delivery.
  • Learn data analytics to determine root cause and investigate system configuration or process changes required for corrective action.
  • Assist with the identification, creation and maintenance of processes needed to support Cost Containment efforts for both Medicaid and Medicare lines of business.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

 

  • Bachelor’s Degree in Business, Finance, Health Administration, Mathematics, Information Systems or related fields of study preferred.

SPECIAL KNOWLEDGE AND/OR SKILLS

 

  • Proficiency in Microsoft Office Products with emphasis on Excel (must be able to create formulas and analyze data and strong use pivot tables)
  • Demonstrated ability in compilation, analysis, and presentation of data.
  • Ability to work independently and manage multiple tasks and priorities.
  • Ability to effectively communicate both verbally and in written form with various levels of employees throughout the organization.
  • Work effectively in a fast past paced, collaborative team environment across the corporate spectrum with attention to detail orientation.
  • Experience in supporting end users in a corporate environment.
  • Strong documentation and time management skills.

 WORK BACKGROUND/EXPERIENCE

 

  • Required Minimum 1-2 years of experience data analysis, project management, process improvement and/or report development role.
  • Minimum 1-2 years experience in a Healthcare business/reporting/systems analysis role.

PHYSICAL REQUIREMENTS

Physical health sufficient to meet the ergonomic standards and demands of the position.

 

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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